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BOARD OF PUBLIC WORECS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/16/18 Department Fire <br />BPW Date 10/23/18 Phone 9255 <br />Name Todd Skwarcan, A/C Services <br />0 Legal Attorney Name C. McDaniels <br />4.1 <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />E 0 <br />Policy <br />co Purchasing ❑ M. Schmidt <br />('ht-.rk thp AnnrnnriRte Item Tvne — Required torAll Submissions <br />El Contract <br />[:1 Proposal <br />I Ll Addendum-1 <br />_oAgreement <br />[:] <br />Claim <br />El <br />Bid Openin <br />E] <br />Bid Award <br />❑ Req. to Advertise <br />I El Title Sheet <br />❑ <br />Quote Opening <br />E] <br />Quote Award <br />E] <br />Chg Order No. <br />Lj <br />C/O & PCA No. <br />PCA <br />Ease./Encroach. <br />El Traffic Control <br />El <br />Resolution <br />Other: Specia! <br />Purchase <br />ReAyired information <br />Company or Vendor Name <br />Hoosier Fire Equipment <br />New Vendor <br />MBE/WBE Contractor <br />El <br />❑ <br />Yes E No E] If Yes, Approved by Purchasing <br />MBE [:] WBE <br />Project Name <br />Project Number <br />Funding Source <br />Equipment Purchases/Material & Equipment <br />Account No, <br />287-090�2.422-43.1 0 <br />Amount <br />$69,985.00 <br />Terms of Contract <br />Payment due upon receipt of invoice <br />Purpose/Description <br />SCBA fill station compatible with Scott SCBA equipment; sole <br />source vendor in Indiana. <br />Amount of El increase <br />1:1 Decrease <br />For Change Orders Only <br />$ <br />$ <br />-Previous Amount <br />1$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />PO No. <br />% <br />Dispersal Atter Approval <br />Copy Original <br />El M Todd Skwarcan <br />El El <br />